Provider Demographics
NPI:1891911285
Name:JESME, JOHN LOUIS (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LOUIS
Last Name:JESME
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 5TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-2692
Mailing Address - Country:US
Mailing Address - Phone:763-434-7891
Mailing Address - Fax:763-427-3260
Practice Address - Street 1:1902 5TH AVE
Practice Address - Street 2:STE 5
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2692
Practice Address - Country:US
Practice Address - Phone:763-434-7891
Practice Address - Fax:763-427-3260
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4287111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350003368Medicare ID - Type Unspecified